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CORRESPONDENCE
Year : 2006  |  Volume : 24  |  Issue : 2  |  Page : 149-150
 

Detection of Pneumocystis carinii in Induced sputum samples of HIV positive patients


Department of Microbiology, Government Medical College, Nagpur - 440 003, Maharashtra, India

Correspondence Address:
M Mishra
Department of Microbiology, Government Medical College, Nagpur - 440 003, Maharashtra
India
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DOI: 10.4103/0255-0857.25221

PMID: 16687875

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How to cite this article:
Mishra M, Thakar Y S, Akulwar S L, Tankhiwale N S, Powar R M. Detection of Pneumocystis carinii in Induced sputum samples of HIV positive patients. Indian J Med Microbiol 2006;24:149-50

How to cite this URL:
Mishra M, Thakar Y S, Akulwar S L, Tankhiwale N S, Powar R M. Detection of Pneumocystis carinii in Induced sputum samples of HIV positive patients. Indian J Med Microbiol [serial online] 2006 [cited 2014 Apr 25];24:149-50. Available from: http://www.ijmm.org/text.asp?2006/24/2/149/25221


Dear Editor,

Pulmonary infections are common in human immunodeficiency virus (HIV) positive persons. Pneumoystis carinii (PC), now named as pneumocystis jiroveci , is the most frequently encountered pathogen. The study, carried out from June 1999 to May 2005, comprised as many as 1101 HIV positive persons presumed to be suffering from pneumocystis carinii pneumonia. Induced sputum samples were obtained from these patients and stained with Gomori's methenamine silver stain (GMS), toludine blue stain and Giemsa stain. Of the 1101 samples, PC was detected in 279 (25.34%). Earlier reports from India have reported its prevelance to be 17 to 55%.[1],[2],[3],[4] Males (26.76%) were more than females (20.83%) in positivity. The year wise distribution of patients and PC positivity showed a gradual increase over the years [Table - 1].

This rise in Pneumocystis carinii corresponds with increase in HIV positive individuals over the years but the percent prevalence of PC has been increasing as well. This may be attributed to increasing number of HIV positive cases, availability of the diagnostic facilities and increasing awareness. Induced sputum used in the present study is easier to obtain than bronchial lavage or lung biopsy. It is more suitable for moderately equipped set ups where special facilities may not be readily available or affordable by the patient. Many authors have found induced sputum to be useful for PC detection.[1],[2],[3],[5] The HIV infected cases may therefore be spared from uncomfortable, invasive and often repeated biopsy procedures that entail morbidity and additional expense.

Of the 279 PC positive samples, GMS was positive in all 279(100%), toludine blue in 279(98.2%) and Giemsa in 256(91.776%). GMS stains the merozites as well as the cyst wall and detection is easier. But it is expensive and cumbersome to perform. Toludine blue stain is also fairly sensitive, stains the merozites and cyst wall. It is simple, rapid and economical. Giemsa stain is the least sensitive of the three, it doesnot stain the cyst wall, hence detection needs some expertise; but it is simple, easy to perform and economical. The use of more than one staining technique does not increase the diagnostic yield. In view of this, it is recommend that touldine blue may be used for routine diagnostic purpose due to its rapidity, simplicity and economy. Giemsa stain may be used in peripheral centres where screening is desired and expertise is available and GMS stain be reserved for confirmation of doubtful results.

 
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1.Rani NU, Reddy VV, Kumar AP, Babu GR, Rao DR. Clinical profile of Pneumocystis carinii pneumonia in HIV infected persons. Indian J Tub 2000; 47 :93-6.  Back to cited text no. 1    
2.Williams J, Thiruvalluvan M, Basker RH. Screening of Pneumocystis carinii in 100 HIV/AIDS Patients. Indian J Sex transm Dis 2002; 23 ;97-101.  Back to cited text no. 2    
3.Usha MM, Rajendran P, Thyagarajan SP, Solomon S, Kumarasamy N, Yepthomi T, et al . Identification of Pneumocystis carinii in induced sputum of AIDS patients in Chennai. Indian J Pathol Microbiol 2000; 43 :291-6.  Back to cited text no. 3    
4.Singh YN, Singh S, Rattan A, Ray JC, Sriniwas TR, Kumar A, et al . P. carinii infection in patients of AIDS in India. JAPI 1993; 41: 41-2.  Back to cited text no. 4    
5.Bigby TD, Margolskee D, Curtis JL, Micheal PF, Sheppard D, Hadly WK, et al . The usefulness of induced sputum in the diagnosis of Pneumocystis carinii pneumonia in patients with the Acquired Immunodeficiency Syndrome. Am Rev Respair Dis 1986; 133 :515-8.  Back to cited text no. 5    


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